Abstract

Background Oncology patients with severe AS are often denied valve replacement. TAVR may be an emerging treatment option.

Methods A worldwide registry was designed to collect data on patients who undergo TAVR while having active malignancy. Data from 222 cancer patients from 18 TAVR centers were compared versus 2,522 “no-cancer” patients from 5 participating centers. Propensity-score matching was performed to further adjust for bias.

Results Cancer patients’ age was 78.8 ± 7.5 years, STS score 4.9 ± 3.4%, 62% men. Most frequent cancers were gastrointestinal (22%), prostate (16%), breast (15%), hematologic (15%), and lung (11%). At the time of TAVR, 40% had stage 4 cancer. Periprocedural complications were comparable between the groups. Although 30-day mortality was similar, 1-year mortality was higher in cancer patients (15% vs. 9%; p < 0.001); one-half of the deaths were due to neoplasm. Among patients who survived 1 year after the TAVR, one-third were in remission/cured from cancer. Progressive malignancy (stage III to IV) was a strong mortality predictor (hazard ratio: 2.37; 95% confidence interval: 1.74 to 3.23; p < 0.001), whereas stage I to II cancer was not associated with higher mortality compared with no-cancer patients.

Conclusions TAVR in cancer patients is associated with similar short-term but worse long-term prognosis compared with patients without cancer. Among this cohort, mortality is largely driven by cancer, and progressive malignancy is a strong mortality predictor. Importantly, 85% of the patients were alive at 1 year, one-third were in remission/cured from cancer. (Outcomes of Transcatheter Aortic Valve Implantation in Oncology Patients With Severe Aortic Stenosis [TOP-AS]; NCT03181997)

Footnotes

Dr. Guerrero is currently affiliated with the Department of Cardiovascular Medicine, Mayo Clinic Hospital, Rochester, Minnesota. Dr. Makkar has been a consultant to or received research funding from Cordis, Medtronic, Cedars-Sinai Medical Center, Abbott, and Edwards Lifesciences. Dr. Taramasso is a consultant for Abbott, Boston Scientific, 4tech and CoreMedic; and received speaker fees from Edwards Lifesciences. Dr. Sinning has received speaker honoraria and research grants from Medtronic, Edwards Lifesciences, and Boston Scientific. Dr. Latib has served on advisory boards for Medtronic and Abbott Vascular. Dr. Windecker has received institutional research grants from Abbott, Amgen, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, St. Jude Medical, and Terumo. Dr. Pilgrim has received institutional research grants from Biotronik, Boston Scientific, and Edwards Lifesciences; and speaker fees from Biotronik and Boston Scientific. Dr. Guerrero has received research funding from Edwards Lifesciences; and has served on the Speakers Bureau for Boston Scientific. Prof. Sievert has received study honoraria, travel expenses, and consulting fees from 4tech Cardio, Abbott, Ablative Solutions, Ancora Heart, Bavaria Medizin Technologie GmbH, Bioventrix, Boston Scientific, Carag, Cardiac Dimensions, Celonova, Comed B.V., Contego, CVRx, Edwards Lifesciences, Endologix, Hemoteq, Lifetech, Maquet Getinge Group, Medtronic, Mitralign, Nuomao Medtech, Occlutech, pfm Medical, Recor, Renal Guard, Rox Medical, Terumo, Vascular Dynamics, and Vivasure Medical. Dr. Watanabe has served as a proctor for Edwards Lifesciences and Medtronic. Dr. Kodali is a consultant for Abbott Vascular, Merrill Lifesciences, Claret Medical; is on the advisory board for Dura Biotech, Thubrikar Aortic Valve Inc., Biotrace Medical; received honoraria from Abbott Vascular, Merrill Lifesciences, and Claret Medical; and received equity from Thubrikar Aortic Valve, Inc., Dura Biotech, BioTrace Medical, and Microinterventional Devices. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.